'Complicated' hypertension: Update on therapy

The current paradigm for treatment is based on the concept of total risk, not just sphygmomanometer readings. Controlling hypertension is particularly important in patients who are elderly or who have diabetes mellitus. In general, uncomplicated hypertension in the elderly can be managed most effectively and inexpensively with diuretics; however, β- blockers are preferred for elderly patients with a history of myocardial infarction. In diabetic patients, diuretics and β-blockers can reduce the risk of cardiovascular disease; angiotensin-converting enzyme inhibitors may limit the progression of renal disease in patients with diabetes and renal dysfunction. Blood pressure reduction alone appears to be crucial for preventing stroke and heart failure in hypertensive patients, and the specific drug choice may not be of primary importance. Lifestyle modifications to prevent or control hypertension include weight loss, moderate alcohol intake, increased physical activity, and reduced sodium intake.